Posted on 03/11/2006 6:09:56 PM PST by sionnsar
On June 13th, I will have been a physician for twenty five years. Twenty four of those years, exactly one half of my life, will have been spent as a neurologist. I would like, therefore, to state for the record, how grateful I am to have been allowed to practice as a neurologist, during this, the profession’s best of times.
When I first began my neurology residency 24 years ago, the practice of neurology was described to me in the phrase “diagnose and adios”. Neurologists were great at diagnosing, based on history and physical examination, where precisely a lesion in the brain might be. However we were unable to do much about most brain diseases. Now, neurology has hundreds of different drugs and treatments, and we can make a profound impact on the lives of the people who come to us for help. The number of seizure medications has increased five fold, and interventions such as seizure surgery and vagal nerve stimulation have made an enormous difference in giving our patients back their lives. Diseases such as multiple sclerosis and Parkinson’s disease have numerous specific therapies including surgeries, as do various brain tumors, and a host of other illnesses.
It has been an awesome time to be a neurologist, and I have been fortunate to work in almost every part of neurology. I am board certified in five different areas of Neurology. I get to see folks with rare genetic illnesses, less rare nerve and muscle diseases, more common headaches, pain syndromes, sleep disorders, and seizures. I see little kids and the elderly. I see teenagers from broken homes with “attitude problems” and wealthy executives with (in my opinion) even worse “attitude problems”. During the course of my day, children and the adults of every sort and condition come in and out of my office. I interpret brain wave tests and sleep studies, I do pain procedures, adjust stimulators, and study nerve and muscle conduction and function. I can honestly say that I love what I do, and I’m lucky to be a neurologist. I’d do it again in a heartbeat.
But my kids won’t be neurologists, or physicians of any kind. I have counseled them very strongly against entering medicine (they didn’t want it anyway). If they were to enter medicine, neurology would be the worst field that they could possibly enter. In about 10 years, I anticipate either leaving medicine entirely or changing to be either a full time sleep physician, a high school science teacher or an “urgent care” physician. As it is, the next 10 years will be spent engaged in “dialogue”, “listening” and “conversation” about when “hypothetically” (there has been a slight shift from “whether”) it would ever be ethical for a physician to deny care (including food and water) to her patients, and the central role and “ministry” of a neurologist in determining which patients have such low “quality of life” that any care would be “futile”. It is anticipated, in the brave new world of the future, that neurologists will become critical to medicine in determining whose lives are worth living. We already assist in the determination of brain death and “persistent vegetative state”, so we are the natural specialists for this role also. As the products of the post-war Baby Boom retire, this role will become critical to the fiscal stability of health care financing, and will contribute enormously to the “quality of life of society.” So say the shiny newsletters that come to my home, and many of my colleagues seem enthusiastic about the important new role that will one day likely be thrust upon neurologists everywhere.
Of course nobody would be “forced” to do anything they thought was wrong. But insurance would look askance at a neurologist who refused to “do the right thing” and who continued to provide “futile” care. Also, naturally, refusal to “do the right thing”, and assist in terminating those whose “quality of life” failed to meet societal norms, would be considered “abandonment”, “inappropriate intervention”, or “abuse” and would likely be met with other sanctions from medical boards and hospital ethics committees. That has been what has happened to other specialties during my career. I recall a time, early in medical school when obstetricians and gynecologists often refused to prescribe birth control pills, especially to unmarried women. This largely is no longer an option. Indeed, in New York Obstetrics/Gynecology residents are forced to learn how to perform abortions, regardless of their religious beliefs. In 1997, the American College of Obstetrics and Gynecologists tried to make such training mandatory everywhere (though their requirements were softened by a handful of pro-life Obstetricians). As it was, changes in ACOG credentialing have made it difficult for pro-life resident training programs to remain accredited. These, together with Catholic hospital training programs, will slowly close over the next decade. However this probably will not change the United States much at this point in medical history. There are very few pro-life Obstetricians and Gynecologists in business nowadays anyway. Obstetricians figured out a long time ago, that if they began seeing a pregnant woman whose baby turned out to have Down’s syndrome, they would be forced to provide an abortion or be charged with abandonment of a patient if they refused.
When I began the practice of neurology, a quarter of a century ago, I often saw children with Down’s syndrome. Now, there are none. As the only neurologist who sees children in a 300 mile radius of a very rapidly growing metropolitan area, I’ve not seen a single case in 2 years. Genetic testing has ensured that virtually all Down’s children are aborted during pregnancy, despite the fact that many children with Down’s syndrome have normal intelligence. Pro-life obstetricians have largely disappeared from US medicine. With the exception of the handful of Obstetricians and Gynecologists physicians in the American Association of Pro Life Obstetricians and Gynecologists, they are now in other walks of life. They left the practice a long time ago.
More recently pharmacists have been fired for refusing to fill prescriptions for birth control drugs or abortifacients. On one occasion, a pharmacist who refused to fill a University of Wisconsin student’s birth control pill prescription was not only fired, but was fined and ordered to take “ethics classes”. Although some Wisconsin lawmakers have been sympathetic to pharmacists forced to violate their religious beliefs, others feel that pharmacists have no right to personal conscience. Under the pressure of planned parenthood of Wisconsin, new legislation has been introduced, called “The Patient Protection Act”. This makes it even clearer that religious objections to pharmaceutical abortion will not be tolerated in Wisconsin, and (to use Planned Parenthood’s words”) “ensures that patients will not be abandoned by pharmacists seeking to elevate personal beliefs above patient care.”
“Abandonment”. This used to be a charge leveled against physicians and others who refused to provide care they felt was appropriate to a patient. Now a pharmacist who refuses to kill a hundred+ cell blastocyst by means of hormonal drugs is charged with “abandoning” a patient. If an obstetrician refuses to kill a developing baby in a mother for whom he cares, he may also be charged with “abandoning” his patient. So I find reassurance that neurologists would never be forced to assist in suicide or euthanasia of those whose lives are thought “futile” unlikely. If pharmacists and obstetricians can be charged with abandonment if they refuse to kill a developing baby, why would we escape? It is only a matter of time before “dialogue” becomes compulsion, and refusal to kill becomes “abandonment”. Catholic hospitals were forced to provide abortions long ago in Belgium, and three years ago were forced to participate in euthanasia. Currently, Catholic hospitals in California are under attack for refusing to participate in abortion, and we are engaged in “listening” regarding “futile care”.
So, I do not see myself remaining a neurologist when the boom is lowered on the Boomers, even though I have been repeatedly informed that no neurologist would ever, ever, EVER be required to violate his or her conscience. Right now we are all just “listening” to one another. We are all just “concerned”, well meaning physicians who are engaged in “conversation” and “discernment”. And it’s Lent! We are supposed to take stock and “listen”, right?
But of course, as a former Episcopalian, I know only too well where “dialogue”, “conversation”, “listening” and “discernment” can end. Lent may be about “being called to listen”, not simply about “penitence”. However “listening” is another of those words that has incurred a set of nasty overtones from the culture wars, much like “gay” for anyone who follows the Anglican troubles. Give me honest “penitence” any day of the week. Repentance, and amendment of life may be unpleasant, but it is, at least, something I understand.
However, I do believe that I have ten clear years. By that time, assuming the “listening” process has not actually resulted in repentance, penitence, and conversion of hearts, I hope to have “reinvented myself” into another career, and will have, God willing, provided for my children’s college education. More importantly, I hope, at least, to have changed the way folks in my community view children with learning disorders and autism. That is critical. For if I don’t, I can tell you the names of at least some of the individuals whose lives will one day be deemed futile. I can see their faces. If I close my eyes and “listen” carefully enough I can almost hear their names . . .
Maria . . .Chad. . . Guillermo . . .John . . .Robert . . .Sarah . . .Patrick. . .Isaac. . .Alena. . .
You know I'm always delighted to help you out. :-)
I was just telling my husband that I've heard from "Down's parents" that their children are the most loving and happy children they've ever had or seen. All they want is to love you.
You're SO sweet :). These days I use all the help I can get, with humble thanks!
I have a cousin with Downs and she sounds like your neice. I smile just thinking about her. But, I had never heard of what the author said that 'many children with DS have normal intelligence'. I was wondering if the author was incorrect in this statement. And I believe he is incorrect.
Elaine loves NASCAR and Jeff Gordon. We have a large family and everyone loves her. She gets lots of teasing and she loves it. She can dish it out, too.
To be sure, this is not light reading, but it does seem to shed new light on old and perhaps prejudicial perceptions.
http://home.vicnet.net.au/~borth/DOWN1.HTM
Come Lord Jesus.
Good is evil, and those who are supposed to heal now kill.
Many Down's Syndrome persons can live normal functional and productive lives. Most are about the most trusting and loving people you'll ever want to meet. When I was in the 7th & 8th grade some of my best friends in school who had disorders ranging from Polio, autism, MD, CP, Blind, to Deafness plus a few Downs as well would be considered unworthy by the murder mills.
Those two years were to change my life forever and open me up for some reality to come my way later as a young adult & continuing into my middle age.
I have heard this so many times...
I've heard this before and briefly worked with Down's children at a clinic. These are children who almost never live to adulthood, who are physically and mentally handicapped, and yet....are loving and seem to bring joy and innocence to their families and all who work with them! Are they a "burden" on society, or could it be they are SPECIAL ANGELS FROM GOD and their purpose in life is to LOVE? Instead of seeing disabled people as unhappy burdens, we need to realize they are GIFTS to us and truly make the world a BETTER place.
These people are blessings. Liberals are burdens.
I was gone for the weekend, but I thank you for the ping! I must add this good doctor to my prayer list. I shed tears for what we have become as a society. We must continue to have courage to speak up and speak out against these outrages.
Excellent post!
The American Revolution has, so far, led to the ongoing holocaust of the unborn ... sometimes I begin to think that the monarchists amongst us may possibly have a point.
Thank you for your kind words about my blog.
I think it was probably not futilitarianism - just plain ol' dumb 'cause we didn't think of all the possibilities.
My mother has been very sick over the last 2 years with a wild and crazy diagnosis of thymic carcinoma followed by a persistent paraneoplastic syndrome. If she didn't have a daughter who's an RN and one who's an obsessive-compulsive (when it comes to my moma) Family doc, I don't think - no, I'm pretty sure she wouldn't have survived.
We had to go through the "No, she never smoked." And "No, it's not Parkinson's, it's like myasthenia gravis because of her tumor." And "NO it's not lung cancer no matter what the pathology report says - it's in her THYMUS, so it's THYMIC carcinoma, even if it's squamous cell, small cell type." And -- worst of all -- "Please put her back on the pyridostigmine and steroids so she can roll over in bed and maybe even sit up again, like last week."
Sorry, I had to rant.
Ok. Sometimes doctors are human. We have a saying,"If you hear hoofbeats in Texas, it's probably horses, not zebras."
But, dog gone it, sometimes it's Zebras! And patients shouldn't have to have their own medical staff in order to survive.
That said: the secret to good medical care is to find a good nurse that you like. Feed her chocolate. Call her on her birthday. And ask *her* for help with the doctor.
(I must be having some sort of loose day - I've never said all this before)
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